Healthcare Provider Details

I. General information

NPI: 1699138990
Provider Name (Legal Business Name): RACHEL THORSTENSON CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2016
Last Update Date: 04/14/2024
Certification Date: 04/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7451 GIRARD AVE
LA JOLLA CA
92037-5143
US

IV. Provider business mailing address

7451 GIRARD AVE
LA JOLLA CA
92037-5143
US

V. Phone/Fax

Practice location:
  • Phone: 217-419-0271
  • Fax:
Mailing address:
  • Phone: 217-419-0271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209014097
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberNA95002253
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: